Dural Reconstruction with or without A Bone Graft Following Oncologic Resections of Paranasal and Anterior Skullbase Malignancies

The reconstruction of frontobasal defects following oncologic resections of paranasal and anterior skull base malignancies remains challenging. Ineffective reconstruction could lead to cerebrospinal fluid leak, meningitis, and tension pneumocephalus. Aim of this investigation was to analyse postoperative complication rates with or without bone graft for anterior skull base reconstruction. In this retrospective study, we included patients following resection of paranasal and/or anterior skull base malignancies between October 2013 and November 2020. Complications were analysed with regards to the type of skull base reconstruction. Ten patients were identified (2 female, 8 male, age (median, SD) 65±14.8 years (range 38 – 81). There were eight cases of paranasal sinus and nasal cavity carcinomas and two cases of olfactory neuroblastomas. Overall survival was 20±25.1 months (range: 5-72), progression free survival was 17.0±20.3 months (range: 4-72). Bone skull base reconstruction using a split graft was performed in three cases. Postoperative complications requiring surgical intervention were seen in 33% (one tension pneumocephalus) of cases in the bone reconstruction group and 57% (three patients with cerebrospinal fluid leak, one infection) in the non-bone reconstruction group. Additional bone reconstruction of the anterior skull base seems to lower the CSF leakage rate due to the additional abutment following resection of paranasal and anterior skullbase malignancies.